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ITP - T cell count - medication
Dec 21, 2002

I have been poz now since Jan 2002 - had regular tests prior(every 3-4 mths) and my latest T cell count was 850 and viral load 17,000 - my glands around the neck area are also slightly swollen but not tender - the Dr had told me that as I do not have a Spleen (removed as a result of ITP in 1987 and have been very healthy since)my T cell count is running at 13 a time when medication should be considered. He said the count of 850 in people without a spleen should be divided by a third for the true count. Is this correct and should I consider medication if I feel ok both physically and mentally? Cheers, "Downunder"

Response from Dr. Young

Dear Downunder,

Thanks for your question, though I have to admit that I am a little confused by the values that you've cited.

Yes, persons with their spleens removed tend to have higher CD4 absolute counts that others, hence using the absolute CD4 cell count for clinical decision-making in this situation can be inaccurate. What I use more and more in making the decision to start medications is CD4 percentages-- in this situation, splenectomy does not affect percentages too much, and this lab parameter can be used to assess immunological health.

Using percentages; a absolute "normal" count of 200 is roughly equal to 15%; 300 CD4 (absolute) is roughly equivalent to 23%. This later value is the one that I start to consider the initation of HAART.

As for starting while you have no symptoms-- I don't think that this is unreasonable if your count (or percentage) places you at risk for having an HIV complication. Remember that the reason to start treatment is to avoid complications-- some of these complications can be very serious or even life threatening. Additionally, there is a sentiment that avoiding therapies might avoid certain types of complications, like lipodystrophy. Recent information from the World AIDS conference and the ICAAC meetings suggests that delaying therapy places persons at greater risk of developing lipodystrophy.

Hope this is informative. -BY


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